Cardiovascular medicine continues to advance at a remarkable pace, driven by innovation, interdisciplinary collaboration and an ever-deepening understanding of disease mechanisms. As patient populations age and chronic conditions become increasingly complex, the field stands at the intersection of precision therapy, digital health and preventive strategy. This winter issue of Heart International reflects that transformation, highlighting progress across interventional cardiology, imaging, metabolism and rehabilitation, while underscoring the enduring importance of evidence-based care and equitable access to innovation.
In this issue, Saliha Erdem et al. revisit one of the most defining questions in modern structural heart disease: the long-term equivalence of transcatheter and surgical aortic valve replacement. Their editorial on the Evolut Low Risk Trial provides reassuring 5-year data, demonstrating sustained non-inferiority of TAVR compared with surgery for mortality and disabling stroke in low-risk patients, alongside excellent valve durability and quality-of-life outcomes. These findings reinforce the paradigm shift toward less invasive valve therapies in populations once considered the exclusive domain of surgery.
Rajkumar Natarajan et al. in their Practice Pearl on the “avoid, recognize, manage [dissections] (ARM) strategy” for drug-coated balloon (DCB) angioplasty, remind us that technological evolution in coronary intervention often benefits from revisiting foundational principles. Their practical framework offers an essential guide for optimizing angiographic outcomes in DCB-only procedures, bridging the lessons of early balloon angioplasty with the sophistication of contemporary “leave nothing behind” strategies.
A rapidly growing area of cardiovascular science, the gut–heart axis, is explored by Sudeep Edpuganti et al., who review emerging evidence linking microbiome dysbiosis with atherogenesis, inflammation and myocardial remodelling. Their article underscores the translational potential of microbiome modulation through dietary, probiotic and postbiotic interventions, while calling for standardized trials to define causality and therapeutic value in cardiovascular disease prevention.
Addressing another critical frontier, Amelia Power and Dinesh Kalra’s review examines persistent sex disparities in dyslipidaemia from screening to treatment that continue to disadvantage women despite advances in lipidology. They highlight the biological and systemic contributors to underdiagnosis and undertreatment, advocating for sex-specific risk assessment tools, equitable clinical trial representation, and heightened clinician awareness to close this longstanding gap in preventive cardiology.
In the realm of cardiovascular imaging, Nia Abbas et al. review epicardial fat density (EAT) as an emerging imaging biomarker of inflammation and cardiovascular risk. Moving beyond conventional calcium scoring, they discuss how EAT volume and attenuation provide complementary insights into local metabolic activity and coronary vulnerability, offering a promising avenue for earlier detection and more refined risk stratification.
Digital innovation takes centre-stage in Derren Rampengan et al.’s systematic review and meta-analysis of eHealth-supported self-management in heart failure. Synthesizing data from over 13,000 participants, their analysis demonstrates a significant reduction in heart failure–related admissions with telemonitoring interventions. While effects on mortality and quality of life remain inconclusive, the study highlights the growing role of digital health in optimizing long-term outcomes and resource utilization in chronic heart failure care.
In our final review, Victor Joseph et al. compare high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) in heart failure rehabilitation. Their results affirm the superiority of HIIT in improving left ventricular ejection fraction, peak oxygen uptake and functional capacity, outcomes that underscore the therapeutic value of structured, high-effort exercise in restoring cardiopulmonary resilience.
Together, the contributions in this issue illustrate both the breadth and depth of contemporary cardiovascular research, from molecular and metabolic discovery to the refinement of interventional technique and digital care integration. As we look toward 2026, Heart International remains committed to advancing dialogue, rigor, and collaboration in pursuit of better cardiovascular health worldwide.
Magdi El-Omar
Dr Magdi El-Omar is a consultant interventional cardiologist at the Manchester Heart Centre and an honorary senior lecturer at the University of Manchester, Manchester, UK. He graduated from St Bartholomew’s Hospital, London, UK, in 1988 and undertook his postgraduate general medical training in London and Oxford. He then completed his general cardiology training in Birmingham, Oxford and Wales before subspecializing in coronary intervention. The latter included a 2.5-year clinical/research fellowship in interventional cardiology at the Cardiovascular Research Foundation and the New York University Medical Centre, New York, NY, USA. During his time there, he worked closely with leaders in the field, including doctors Greg Stone, Martin Leon, Gary Roubin, Frederick Feit and Aaron Marcus. Dr El-Omar has been involved in research for over 25 years. He undertook a 2-year British Heart Foundation Junior Research Fellowship in basic science (diabetic cardiomyopathy in a rat model) in 1997–8, which led to the award of an MD degree from the University of London. He has since been actively involved in clinical research, especially in the fields of acute coronary syndromes and coronary intervention. He has authored more than 70 peer-reviewed articles, mostly in high-impact journals. He has been a local principal investigator for several landmark, international, multicentre trials (e.g. HORIZONS-AMI, INFUSE-AMI, TOTAL, TWILIGHT, etc.). He is actively involved in education and training and is a course co-director of the International Complex Cardiovascular Catheter Therapeutics Conference in the USA.
